Effects of an expressive writing intervention on a group of public employees subjected to work relocation

Abstract

BACKGROUND:

Pennebaker’s writing technique has yielded good results on health, psychological and performance dimensions. In spite of the positive outcomes, the technique has rarely been applied directly within the workplace and its effects on burnout have never been tested.

METHOD:

18 public employees subjected to work relocation were asked to write about their present work situation or another difficult event of their life (Writing Group), while another 17 were not assigned any writing task (Control Group).

OBJECTIVE:

To assess whether there was an improvement in burnout, alexithymia and psychological well-being in the Writing Group compared with the baseline measurement and the Control Group.

RESULTS:

While the baseline levels in the Writing and Control Groups in the 3 dimensions considered were similar, scores in the Writing Group at both a second (1 month after the end of the procedure) and third measurement (7 months after the end) improved when compared with the baseline, whereas those in the Control Group worsened.

CONCLUSIONS:

Pennebaker’s writing technique appears to promote adaptive coping strategies in stressful situations, and to increase occupational and psychological well-being as well as the ability to process emotions. It also appears to buffer the negative effects of work-related stress.

Keywords

Occupational well-being burnout alexithymia work-related stress

1 Introduction

The economic crisis that started in Europe and North America in 2007 has led to a significant decline in economic activity, to a rise in unemployment and to a growing number of people living in poverty. The crisis has been accompanied by expanding national debts that have forced governments to implement severe cuts in public spending.

In Italy, a major spending review has led to a deep reorganization of public services, forcing workers to deal with important occupational changes, including new duties and colleagues, as well as new workplaces that may force them to move to offices that lie kilometers away from their former offices. All these work changes increase not only the cognitive and emotional demands of work [1] but also levels of work-related stress, leading to absenteeism [2] and reduced psychophysical well-being among employees. Psychological well-being is, however, known to contribute to economic productivity and prosperity and to be crucial to economic growth [1]. Indeed, an estimated 20.000 billion Euros are believed to be wasted every year in Europe as a result of occupational stress-related issues [3].

On the basis of these findings, we decided to administer an expressive writing intervention to a group of public employees subjected to major work reorganization and to work relocation, which was in some cases a long way from their former offices. We adopted Pennebaker’s writing technique since it appeared to match the needs of the workers and to address their work issues, which may be expressed through absenteeism and burnout. There was an assumption that this technique might lead to increased productivity. Pennebaker's technique, which is inexpensive to administer, provided positive results in a wide range of contexts.

1.1 Psychological effects of work relocation

The evolution of the economic system in most European countries and the U.S. has led many companies and organizations to reorganizing, downsizing and relocating, thereby creating feelings of insecurity in workers regarding their role, duties and permanence in the company [4].

This process has resulted in heavier workloads and/or in a rise in job insecurity, a dimension considered as a work stressor in various theoretical models of work psychology [5 –7]. Therefore, it is not surprising that job insecurity has a negative impact on employees’ health and well-being.

In recent decades, numerous studies have examined the psychological effects of job insecurity on individual and organizational dimensions. With regard to individual dimensions among workers, a correlation has been observed between high job insecurity scoresand:

worse health conditions [8]

psychological stress and burnout [9, 10]

dissatisfaction with their own lives [11]

reduced self-esteem [12]

increased levels of irritation and anxiety [13, 14]

increased levels of psychosomatic complaints [15]

With regard to organizational dimensions, a correlation has emerged between high job insecurity scores and:

less job satisfaction and sense of belonging to the organization [11 –16]

absenteeism, late attendance of work and an inclination to avoid tasks and responsibilities [10]

Moreover, longitudinal studies have shown that job insecurity is more detrimental to an employee’s well-being than the certainty of dismissal [9].

Work relocation is also related to exhaustion and withdrawal intentions [17], and can lead to reduced job satisfaction [18], a dimension that is known to becorrelated with burnout [19, 20] and to directly affect the family and relational life of relocated workers [21].

1.2 Occupational burnout

The construct of occupational burnout was first conceptualized by Maslach in 1982 as a chronic stress syndrome, specifically related to helping professions, and then re-conceptualized as an individual response to chronic, work-related stress that drives workers to emotional and psychophysical exhaustion and to a deterioration of dedication [22]; the burnout construct was subsequently extended to all professions.

Burnout is characterized by 3 dimensions: exhaustion (feeling overextended, both emotionally and physically); cynicism (taking a cold, cynical attitude towards work responsibilities) and professional ineffectiveness (feeling a growing sense of professional inadequacy).

1.3 Alexithymia

The term alexithymia (literally “no words for feelings”), coined in 1973 by Nemiah and Sifneos, identifies a particular construct [23] characterized by: (1) difficulty in identifying feelings and distinguishing between feelings and bodily sensations of other origin; (2) difficulty in finding words to describe feelings to other people; (3) constricted imaginal processes, as evidenced by a paucity or absence of fantasies referable to drives and feelings; and (4) thought content characterized by a preoccupation with minute details of external events. Alexithymic subjects also show a lack of empathy [24] because they cannot readily imagine themselves in another person’s situation and consequently are ineffective in appreciating the emotional states of others. Alexithymia is a deficit that can be more or less severe and can appear after a particular event or trauma and affect the whole life of an individual, or only particular “mental areas”.

Alexithymia has very important effects in the workplace because it negatively affects the relationship between co-workers as well as between workers and clients [25, 26] and is related to occupational stress [27]. It also disturbs the production capability, the decision-making process and the creation of a cooperative environment in the workplace.

Alexithymia and burnout are closely linked, as demonstrated by the fact that high scores in the Toronto Alexithymia Scale (TAS-20) are positively correlated with high scores in the Maslach Burnout Inventory (MBI) scales [28 –30]. These findings highlight the importance of promoting thinking about work-related events and feelings as a means of improving psychological and occupational well-being.

1.4 Pennebaker’s writing technique

Pennebaker’s writing technique consists of a careful, written re-examination of an important life event in order to incorporate it in a more coherent narrative of the self and to find any links and effects between this event and relational and psychological dimensions. This technique provides a type of disclosure that, rather than simply evacuating traumas and emotions related to them, helps to re-elaborate traumatic experiences in a cognitive and emotional way. This gives individuals a sense of predictability and control over their lives. Once an experience has structure and meaning, it follows that the emotional effects of that experience are more manageable. Constructing stories facilitates a sense of resolution, which results in less overthinking and eventually allows disturbing experiences to subside gradually from conscious thought. Painful events that are not structured into a narrative format may contribute to the continued experience of negative thoughts and feelings [31].

In the standard procedure, writing groups are asked to spend 15 to 30 minutes each day writing about the topics they have been assigned for a certain number of days. Those persons that are assigned to the experimental group are instructed to write about a trauma or an important event of life, relating it to their own childhood, their present, their future and their relationships.

While the original writing studies asked people to write about traumatic experiences, later studies expanded the scope of writing topics to include general emotional events or specific experiences shared by other participants (e.g. diagnosis of cancer, losing a job, going to college). The amount of time people were asked to spend on their writing varied from 10 to 30 minutes for 3 to 6 sessions, spaced in different patterns [32].

Several studies have shown that this technique is effective in a wide variety of dimensions such as psychophysical well-being [33 –35], relational stability [36], depression and alexithymia in post-partum [37], recovery from surgical interventions [38] and performance dimensions such as school results [39].

Despite the efficacy, versatility and inexpensiveness of Pennebaker’s writing technique, it has been applied to working situations surprisingly rarely if we bear in mind the significant and positive effects of the technique on important work-related dimensions such as psychological well-being, personal efficacy, physical health or distress. One explanation for the very limited use of this technique may be the strong resistance that is encountered in both in Italian private and public companies when any attempt is made to introduce different psychological competencies other than those required for the recruitment of workers.

The few work-related studies that have been published on this topic support the efficacy of the writing technique in the following dimensions: Psychological well-being, anger and intention to retaliate [40]; emotional self-efficacy [41]; perceived stress [42]; absences from the workplace [43], physical health [44]; re-employment ability after a job loss [45, 46].

2 Objectives

As far as we know, no studies have yet been published on the effects of Pennebaker’s writing technique on occupational burnout in working populations. The aim of our study was to verify the effectiveness of the technique on occupational burnout, alexithymia and psychological well-being in a group of employees subjected to work relocation. We hypothesized an improvement of these dimensions in the Writing Group.

3 Method

3.1 Context

In 2009/2010, in order to reduce the costs of public administration and services, the Italian Government passed a law to abolish the administrative division of “Province”, revoking all their political and administrative functions and restructuring their services.

This measure involved about 60,000 workers, 90% of whom had an open-ended contract and 60% of whom had more than 10 years of service.

This restructuring forced thousands of workers with open-ended contracts to undergo the stress induced by the risk of being transferred or having to change duties, roles and colleagues, in the majority of the cases after numerous years of work during which no major changes had occurred. The fixed-term workers were instead faced with increased uncertainty with regard to their work situation and the renewal of their contracts. During this process, neither the government nor the managers of the administrative services proposed any measures designed to help the workers to get through this difficult situation in a way that did not negatively affect them, the services or their users.

For the purposes of our study, we wished to plan a short, inexpensive and effective intervention in an effort to buffer the consequences of this stressful event on the workers’ personal and relational life.

3.2 Why we decided to use Pennebaker’s writing technique

In the large body of literature available on work relocation, there is no shortage of examples of interventions or services adopted to help workers to deal with a process that is associated with a high degree of stress as well as with change and uncertainty. So why did we choose to use a technique that is undoubtedly effective but has rarely been adopted in a workcontext?

The lack of a specific request for intervention did not allow us, for example, to consider setting up a service of personalized coaching for the workers. That solution would have provided personalized care for each case and help for the workers as whole persons, including aspects such as their personality, specifics needs and relationships. Personalized coaching, which would have been unfeasible because of its costs in terms of money and time, appeared also not the most suitable means of working on the relationship between workers because of its individual nature.

We also did not find suitable for our study a thorough investigation of the organization that might have been conducted with an instrument such as the Organizational Checkup System [47]. This tool, which analyses six areas of the working life, i.e. workload, control, reward, community, fairness, and values, provides information on the overall health and well-being of the organization as well as indicators of its possible strengths and weaknesses [48]. The limitations of this instrument, which is better suited to the work environment than to individuals, were the fact that it is more appropriate for large organizations with a range of employees (our organization was small, with 35 employees) [48] and that it is more effective as a preventive intervention [48] than for an “in progress” situation such as the one that we were facing, in which we needed to work quickly in order to limit as much as possible the negative effects induced by the relocation on the workers’ life and job.

With regard to the various expressive writing techniques, we decided to discard all those that focus on only one context (e.g. the working context) and overlook the others (e.g. the relational context) because we have seen that the relocation process affects all aspects of the workers’ lives, their relationships and families. We consequently also discarded a shorter intervention, such as the writing of a letter addressed to a specific person or event [42], because it does not promote reflection on the connection between a particular working situation and everyday and relational life.

The efficacy of Pennebaker’s writing technique on workers’ physical health [33 –35] is easily translatable in terms of fewer absences from work and improved productivity, along with a low cost in terms of money and time, thereby making it the best solution for the management of the employees. Moreover, its efficacy in assessing stress [43], relational stability [36] and alexithymia, a dimension that is correlated with burnout [28 –30] and is linked to the construction and quality of relationships [25 –27], makes it the most suitable technique to use in a situation such as the one we were faced with.

3.3 Subjects

We studied thirty-five public employees of the “Agenzia Per il Turismo” offices (a tourist promotion service) of Siena and Chianciano Terme subjected to work relocation. The subjects (17 males; 18 females) were between 25 and 60 years old (m = 49.94, sd = 10.20), had an average of 14 years of education (thirteenth grade), 11 were affected by chronic diseases and 21 were regularly taking prescriptions. Employees from Chianciano Terme (N = 18) were assigned to the Writing Group (WG) whereas those from Siena (N = 17) were assigned to the Control Group (CG) in order to avoid subjects in different experimental conditions exchanging information. The only subjects who were excluded from the study were the managers of the two offices (Chianciano and Siena) because they were aware of the aims of the study.

3.4 Measures

3.4.1 Occupational burnout

Burnout was measured with the Italian version [47] of the MBI-GS [49], a validated 16-item questionnaire that measures the 3 dimensions of burnout: Exhaustion (5 items), Cynicism (5 items) and Professional Ineffectiveness (6 items). The items were scored on a 7-point frequency rating scale, ranging from 0 (never) to 6 (daily).

3.4.2 Alexithymia

The alexithymia level was assessed using the Italian version [50] of the TAS-20 [51], a validated 20-item questionnaire that yields, in addition to a total alexithymia score, 3 scores connected with 3 factor scales that reflect the 3 main facets of the alexithymia construct: Difficulty Identifying Feelings (DIF); Difficulty Describing Feelings (DDF) and Externally-Oriented Thinking (EOT). The items were scored on a 5-point scale, ranging from 1 (completely disagree) to 5 (completely agree).

3.4.3 Psychological well-being

Psychological well-being was measured with the Italian version [52] of the Ryff Psychological Well-Being (PWB) Scales [53], a validated 84-item questionnaire, measuring 6 different aspects of psychological well-being: Autonomy (sense of independence and self-determination); Environmental Mastery (sense of mastering and competence in managing the environment); Personal Growth (feeling of continuing development); Positive Relations with Others (feeling of having reliable and satisfying relationships with others); Purpose in Life (feeling of having goals in life); Self-Acceptance (positive attitude toward oneself). The items were scored on a 6-point scale, ranging from 1 (completely disagree) to 6 (completely agree).

3.5 Procedures

Phase 1: Both the Writing and Control group subjects were asked to fill in a socio-demographic questionnaire and the TAS-20, MBI-GS and PWB tests.

Phase 2: The 18 Writing Group subjects were asked to write once a week for 20 minutes for 3 consecutive weeks about their feelings and thoughts connected with either a significant work-related event or with another important event of their lives according to the following instructions, which are an adaptation of Pennebaker’s [54] original instructions:

“We know that you’re dealing with significant work-related changes, we would like you to write about your very deepest thoughts and feeling about work relocation. In your writing, we’d like you to really let go and explore your very deepest emotions and thoughts. You might tie this event to your childhood, your relationships with others, including parents, lovers, friends, or relatives. You may also link this event to your past, your present, or your future, or to who you have been, who you would like to be, or who you are now. You may write about the same general issues or experiences on all days of writing or on different topics each day. All of your writing will be completely confidential. Don’t worry about spelling, sentence structure, or grammar. The only rule is that once you begin writing, continue to do so until your time is up.”

Subjects were convened together in a conference room during work time, and once the researcher had read the instructions, the writing session started.

Phase 3: A month after the last writing session, both the Writing and the Control Group subjects were asked to again fill in the TAS-20, MBI-GS and PWB questionnaires.

Phase 4: 7 months after the last writing session, both the Writing and the Control Group subjects were asked to fill in the TAS-20, MBI-GS and PWB questionnaires for the last time.

3.6 Statistical analyses

To evaluate homogeneity, the Writing and Control groups were compared on the basis of independent social, demographic and health variables and on dependent variables at baseline, using the χ2 test for categorical variables and Analysis of Variance for continuous variables. To test hypotheses, we applied repeated measures ANOVA using group (Writing vs Control) and time (baseline vs 1 month after the end of procedure vs 7 months after the end of procedure) as independent variables and the MBI-GS, TAS-20 and PWB as dependent variables.

3.7 Ethics

The procedures regarding confidentiality, in particular the use of an alphabetical code in order to anonymize data, and the use of the data in research and publications were fully explained to the workers, who were aware of the possibility of withdrawal from the study at any time, without giving reasons and without any penalization. Before the beginning of the study all participants were asked to sign informed consent forms. The general results of the investigation were fully disclosed to all the participants via mail and/or telephone. It was unfortunately impossible to organize a presentation with all workers participating because of the logistic issuesgenerated by the work relocation: Many participants were now working in different offices spread all over the region and, in a few cases, the new managers didn’t allow us to give a presentation during office hours. Due to the same logistic problems we also couldn’t repeat the writing procedure with the subjects of the control group, as we had planned to do.

4 Results

The Writing and Control groups did not differ significantly on any independent variable, nor on any dependent variable at baseline (Tables 1 and 2).

Group (Writing vs Control)×time (baseline vs 1 month after the end of procedure vs 7 months after the end of procedure) interactions were significant for all the variables (except PWB-Autonomy and PWB-Purpose in Life) and differences were all in the expected directions. Means, standard deviations, F and p are reported in Tables 3, 4 and 5.

The MBI-GS Exhaustion dimension shows a significant group×time interaction (p = 0.03; F = 3.68).

Duncan’s post hoc tests show a significant difference between the means of the 2 groups both at the 1-month (p = 0.002) and at the 7-month follow-ups (p = 0.0006). The Writing Group mean decreased from 10.72 at baseline to 6.78 at the 1-month follow-up (p = 0.01), and from 10.72 at baseline to 7.78 at the 7-month follow-up (p = 0.04). (Fig. 1)

The MBI-GS Cynicism dimension shows a significant group×time interaction (p = 0.018; F = 4.29).

Duncan’s post hoc tests show a significant difference between the means of the 2 groups at the 7-month follow-up (p = 0.004). The Control Group mean increased from 9.94 at baseline to 14.12 at the 7-month follow-up (p = 0.03). (Fig. 2)

The MBI-GS Professional Ineffectiveness dimension shows a significant group×time interaction (p = 0.035; F = 3.52).

Duncan’s post hoc tests show a significant difference between the means of the 2 groups both at the 1-month (p = 0.002) and at the 7-month follow-ups (p = 0.0004). The Control Group mean increased from 9.76 at baseline to 14.35 at the 7-month follow-up (p = 0.009). (Fig. 3)

The Total Alexithymia dimension (sum of the 3 TAS-20 subscales) shows a significant group×time interaction (p = 0.0002; F = 9.74).

Duncan’s post hoc tests show a significant difference between the means of the 2 groups both at the 1-month (p = 0.002) and at the 7-month follow-ups (p = 0.0001). The Writing Group mean decreased from 49.67 at baseline to 42.28 at the 1-month follow-up (p = 0.005) and from 49.67 at baseline to 39.61 at the 7-month follow-up (p = 0.0003). (Fig. 4)

The TAS-20 Difficulty Identifying Feelings dimension shows a significant group×time interaction (p = 0.01; F = 4.93).

Duncan’s post hoc tests show a significant difference between the means of the 2 groups both at the 1-month (p = 0.016) and at the 7-month follow-ups (p = 0.0004). The Writing Group mean decreased from 17.22 at baseline to 13.39 at the 7-month follow-up (p = 0.015).

The TAS-20 Difficulty Describing Feelings dimension shows a tendentially significant group×time interaction (p = 0.10; F = 2.32).

Duncan’s post hoc tests show a significant difference between the means of the 2 groups both at the 1-month (p = 0.017) and at the 7-month follow-ups (p = 0.002). The Writing Group mean decreased from 15.78 to 12.44 from baseline to the 1-month follow-up (p = 0.008) and from 15.78 at baseline to 11.78 at the 7-month follow-up (p = 0.002).

The TAS-20 Externally-Oriented Thinking dimension shows a significant group×time interaction (p = 0.002; F = 6.77).

Duncan’s post hoc tests show a significant difference between the means of the 2 groups both at the 1-month (p = 0.008) and at the 7-month follow-ups (p = 0.0001). The Writing Group mean decreased from 16.67 at baseline to 14.72 at the 7-month follow-up (p = 0.048), while the Control Group mean increased from 16.47 at baseline to 18.12 at the 7-month follow-up (p = 0.007).

The PWB Environmental Mastery dimension shows a significant group×time interaction (p = 0.042; F = 3.33).

Duncan’s post hoc tests show a significant difference between the means of the 2 groups both at the 1-month (p = 0.0003) and at the 7-month follow-ups (p = 0.0001). The Writing Group mean increased from 59.22 at baseline to 63.67 at the 1-month follow-up (p = 0.042) and from 59.22 at baseline to 64.56 at the 7-month follow-up (p = 0.02).

The PWB Personal Growth dimension shows a significant group×time interaction (p = 0.024; F = 3.94).

Duncan’s post hoc tests show a significant difference between the means of the 2 groups both at the 1-month (p = 0.0001) and at the 7-month follow-ups (p = 0.0001). The Control Group mean decreased from 63.59 at baseline to 59.18 at the 7-month follow-up (p = 0.03).

The PWB Self-Acceptance dimension shows a significant group×time interaction (p = 0.002; F = 6.88).

Duncan’s post hoc tests show a significant difference between the means of the 2 groups both at the 1-month (p = 0.0006) and at the 7-month follow-ups (p = 0.0001). The Writing Group mean increased from 55.17 at baseline to 61.61 at the 1-month follow-up (p = 0.008) and from 55.17 at baseline to 62.67 at the 7-month follow-up (p = 0.003).

The PWB Positive Relations with Others dimension shows a significant group×time interaction (p = 0.0006; F = 8.39).

Duncan’s post hoc tests show a significant difference between the means of the 2 groups both at the 1-month (p = 0.006) and at the 7-months follow-ups (p = 0.0001). The Writing Group mean increased from 61.00 at baseline to 67.61 at the 7-month follow-up (p = 0.004), while the Control Group mean decreased from 62.94 at baseline to 58.41 at the 1-month follow-up (p = 0.045) and from 62.94 at baseline to 57.65 at the 7-month follow-up (p = 0.023).

Effects on the PWB Autonomy (p = 0.12; F = 2.20) and the PWB Purpose in Life dimension (p = 0.118; F = 2.21) were not significant.

5 Discussion

The results largely confirm our hypothesis, i.e. writing about a difficult situation, whether it be in the workplace or elsewhere, improves occupational and psychological well-being in employees and their ability to identify and process feelings. Furthermore, the results of the follow-up provide strong evidence of the stability of changes induced by the writing technique.

The marked improvement within the Writing Group in all 3 occupational burnout dimensions indicates that the procedure constitutes an empowerment path for workers. The decrease in the Exhaustion dimension suggests that workers rediscover fundamental energies and resources to face problems they may have in their working life. The decrease in the Cynicism dimension shows how the employees assigned to the Writing Group rediscover, through writing, a feeling of belonging to their company and to their workplace in general. Lastly, the decrease in the Professional Ineffectiveness dimension highlights how workers return to perceive themselves as capable and effective at work.

The general decrease in burnout shows us how the technique helps workers to positively adapt to the new situation due to the work relocation and to deal with new co-workers, duties and workplaces. This effect is highlighted by the parallel worsening in the means of the 3 burnout dimensions in the Control Group, thereby showing that they perceive work relocation as a negative event that deteriorates the relationship between workers, their organization and their own work.

The marked decrease observed in alexithymia in the Writing Group between the baseline and the 7-month follow-up measurements, which was paralleled by an increase in the Control Group, suggests, on the one hand, that in this case alexithymia is probably a defence strategy adopted by workers to cope with their difficult working situation; on the other, it confirms that the writing technique activates the skills required to process emotional aspects of a significant life-changing event like work relocation. This is specifically supported by the results obtained in the Externally-Oriented Thinking dimension, which is generally considered to represent the defensive or even compensatory aspect of alexithymia. Indeed, the technique appears to help the workers in the Writing Group to activate more adaptive and efficient coping strategies that allow them to deal with change [45] and to promote a more conscious evaluation of their own resources and of those present in their working context.

The positive effects of the technique observed in the Difficulty Describing Feelings dimension demonstrate how the procedure is capable of activating or reactivating a narrative function among workers, thereby helping them to process their emotions. Writing about feelings and thoughts connected with the work relocation allows employees to elaborate and positively assimilate changes [31] and hence assume a more active attitude in the new work context, besides, a positive perception of the working situation may stimulate employees on sick leave to return to work early [55].

As to psychological well-being, we observed significant effects of the technique in 4 of the 6 PWB scales: Environmental Mastery, Personal Growth, Self-Acceptance and Positive Relations with Others. These dimensions highlight the range of fields in which the technique is effective: Environmental, individual and relational. This demonstrates how the technique affects an individual’s whole life, promoting a holistic vision of people and interventions.

In particular: The effects in the Environmental Mastery dimension show that the writing technique improves the feeling of effectiveness in the life context and self-efficacy, a dimension that can lead to a reduction of sickness absence [56], confirming data regarding the Professional Ineffectiveness MBI-GS dimension; the Personal Growth dimension shows how writing helps workers to consider themselves as able to develop their own abilities, in spite of the difficult work situation; the Self-Acceptance dimension testifies that reflection on the working situation helps employees to perceive themselves in a positive way; lastly, the Positive Relations with Others dimension attests that the writing technique exerts a positive effect on the perceived quality of personal and working relationships.

Our study demonstrates that Pennebaker’s writing technique can be considered a remarkably efficient and inexpensive tool that may be used to promote a positive and adaptive coping strategy among employees dealing with work relocation; it also shows how this particular technique affects a range of aspects of working life: Individual dimensions (psychological well-being, ability to process emotions); relational dimensions (relationships in the workplace between co-workers, clients and management); environmental dimensions concerning the whole working context. Dimensions that are known to be related to work engagement [57].

The writing technique allows us to plan an intervention that takes into consideration the peculiarities of the setting and views the worker as a whole person with feelings, needs and expectations, and not just as a tool to fix. Missed recognition of the worker as an important and active part of the production process and as a cardinal component in the improvement of the quality of the service, along with the low consideration in which psychology is usually held by the Italian public administration, highlights the importance of the writing technique as a starting point to more extensive psychology-based interventions.

In view of the good results achieved and the limited number of times this technique has been applied to working contexts, we suggest that research in this field be continued, by using both larger sample sizes and other outcome variables (e.g. number of medical visits or days of absence from work).

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